With London starting to see increased demand from embassy patients, Simon Brignall discusses some essential billing and collection matters you need to be aware of when looking after these patients.
It is key for any business to have a mixture of revenue streams to create a portfolio effect that lessens the impact of shifts in demand – and the private healthcare sector is no different.
There are many patient groups outside of the traditional private medical insurance and self-pay sector where a consultant can operate and generate additional revenue and, in London, treating embassy patients is one such option.
The patient mix of private practices in central London often differs to those practices located around the UK, as practices outside of the capital may include NHS patients being treated in private hospitals.
Many central London-based practices capitalise on the benefits of medical tourism, which can appear in the form of international self-pay patients or patients whose treatment is funded by other countries via their diplomatic mission.
The ‘black swan’ nature of the pandemic and its impact on international travel meant that these patients have been in short supply. The demand from international patients accessing healthcare in the UK saw a significant reduction because the impact of lockdowns and travel restrictions were suffered by overseas patients wanting to come to the UK for treatment.
Signs of recovery
But recent data from market analysts LaingBuisson suggests that this market is showing signs of recovery from the lows of 2020.
There is an expectation that embassy patient activity through central London-based independent hospitals in 2023 will finally surpass 2019 levels by 10%.
So let’s explore embassy work and what you need to know from a billing and collection perspective if you are thinking of including this sector as part of your patient mix.
There are more than 50 embassies within London; however, most of the patients come from the big four, which are Kuwait Health, Kuwait Military, United Arab Emirates Medical and Qatar.
Here are some important things you need to be aware of should you decide to treat this important patient category.
The patients that you will be sent by the embassies often have complex conditions and this is one of the main reasons why they travel to this country.
These can include patients whose previous procedures/treatments were unsuccessful or require revisional surgeries.
Allow enough time
When you see the patients for their consultation, they will normally be accompanied by an interpreter.
This, in combination with the probability of the patient presenting with a complex case, means that the consultation is likely to take longer than normal and so you will need to allow more time in your clinic diary.
Do you have all the necessary documentation?
Before you treat an embassy patient, it is crucial for you to obtain a Letter of Guarantee – referred to as LOG.
The LOG will authorise treatment for the patient and it is important for it to be issued in your name.
This is a precursor to raising an invoice to an embassy, because, without this vital document, it is unlikely your invoice will be paid.
Impact on your cash flow
Probably the most important point to consider about taking on embassy activity is that payment often can take a long time.
The impact this can have on a practice’s cash flow should be understood and may limit the amount of this type of activity you do when compared to other patient groups with faster payment cycles.
As many consultants start seeing embassy patients without having given due consideration to all the points I highlighted above, I thought it would be useful to produce a simple check list to assist you (see the check list below).
As you can see from this article, it is crucial for you to get your practice prepared correctly, preferably before you start treating patients.
Failure to do so could mean that you end up seeing a lot of patients where you end up waiting a long time for payment – or worse, not get paid.
A useful check list for embassy work
Letter of guarantee
It is vital that a letter of guarantee (LOG) is obtained before any treatment is carried out.
This document will vary slightly depending upon the embassy it is issued by. It will typically specify the patient’s demographic details along with the appointment date(s) and the reason for the treatment as well as specifying the consultant and the location.
Always check that the dates specified in the LOG cover the treatment dates on the invoice, as this can often be a reason an invoice is rejected.
There is normally a set of terms and conditions covering the LOG and you must always submit this document in conjunction with your invoice to the embassy in a timely manner to ensure the best possible chance of receiving payment.
Some embassies also require a medical report along with the invoice and LOG. If this process is not followed correctly, then you run a much greater risk of treating patients without getting paid.
Anaesthetists will require a LOG in their own name, not the name of the surgeon carrying out the operation.
Your treatment fees need careful consideration before you start to see patients, as your patient may require a mixture of inpatient and outpatient consultations, inpatient care, procedures and occasionally intensive care.
Procedure pricing should also consider the level of complexity, especially when it is beyond the scope of what is described by the Clinical Coding and Schedule Development group (CCSD) schedule.
Your fees may also want to reflect the impact of some of the other issues I have discussed that arise when treating this patient group.
Whatever your decision, it is important that this is communicated clearly to the relevant embassy to avoid any misunderstanding or disputes about payment.
Delayed payment cycle
Be prepared for the extended duration of the embassies’ payment cycles and allow for this within your practice’s cash flow.
There are taxation impacts to consider, as you may find yourself paying tax to HM Revenue and Customs (HMRC) on invoices that have still not been paid. This could have a devastating effect on your cash flow if you have not planned accordingly.
Make sure you have a robust system in place to chase for payment and that it is routinely followed to ensure your money is collected.
The embassies are always busy, particularly the big four, and it is not uncommon for them to have a sizeable backlog of invoices waiting to be paid.
It is vital to keep a record of when and how your invoices were sent to the relevant embassy and copies of all supplementary documentation provided in case they get misplaced.
It is important to monitor your outstanding debt and should you continue to have issues collecting payment with a particular embassy, then you need to think long and hard about taking on other cases from them until the problem is addressed.
Chasing outstanding money on a continual basis is the hardest part of this whole process, because most practices are not geared up for this.
It is both time-consuming and requires a specific skill set. It is rare to find a practice which has the time to chase these invoices on a continual basis and maintain adequate records to support this.
Simon Brignall (right) is head of sales at Civica Medical Billing and Collection